| Otis R Bowen Center | |
|
850 N Harrison St Warsaw IN 46580-3163 | |
| (574) 267-7169 | |
| (574) 269-3995 |
| Full Name | Otis R Bowen Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 850 N Harrison St, Warsaw, Indiana |
| Authorized Official Name and Position | Jay M Baumgartner (SR VP FISCAL DIVISION) |
| Authorized Official Contact | 5742677169 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Otis R Bowen Center 850 N Harrison St Attn: Anne Lawson - Performance Improvement Warsaw IN 46580-3163 Ph: (574) 267-7169 | Otis R Bowen Center 850 N Harrison St Warsaw IN 46580-3163 Ph: (574) 267-7169 |
| NPI Number | 1639172810 |
|---|---|
| Provider Enumeration Date | 05/23/2005 |
| Last Update Date | 12/04/2012 |
| Medicare PECOS PAC ID | 7618950965 |
|---|---|
| Medicare Enrollment ID | O20050404000853 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639172810 | NPI | - | NPPES |
| CB5225 | Other | IN | RAILROAD MEDICARE |
| 452270 | Other | IN | MEDICARE |
| 100273680A | Medicaid | IN | |
| 100428290A | Medicaid | IN | |
| 169430 | Other | IN | MEDICARE |
| CH1896 | Other | IN | RAILROAD MEDICARE |
| 452280 | Other | IN | MEDICARE |
| 000000202972 | Other | IN | ANTHEM BLUE CROSS BLUE SHIELD |
| 100156770 | Medicaid | IN |
| Provider Name | Mahender R Surakanti |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1417940909 PECOS PAC ID: 7911981030 Enrollment ID: I20040616000686 |
| Provider Name | Vijoy K Varma |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1912978909 PECOS PAC ID: 0547246068 Enrollment ID: I20040625000740 |
| Provider Name | Carolyn Greer |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1568458990 PECOS PAC ID: 3870566656 Enrollment ID: I20040818001438 |
| Provider Name | Scott J Mcalister |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770583718 PECOS PAC ID: 3779519657 Enrollment ID: I20050712000813 |
| Provider Name | Gerald Kevin Greer |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1700882701 PECOS PAC ID: 8628096542 Enrollment ID: I20051109000030 |
| Provider Name | Hani Ahmad |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1790711604 PECOS PAC ID: 4385740059 Enrollment ID: I20070426000561 |
| Provider Name | Diedra Hayman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1053435552 PECOS PAC ID: 4082709043 Enrollment ID: I20071005000077 |
| Provider Name | Pamela Schwartz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679639942 PECOS PAC ID: 0042317208 Enrollment ID: I20080911000051 |
| Provider Name | Lisa A Bergeron |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1801890355 PECOS PAC ID: 0244397602 Enrollment ID: I20090330000489 |
| Provider Name | Beverly A Benner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245378579 PECOS PAC ID: 6901952886 Enrollment ID: I20090917000314 |
| Provider Name | Patricia J Rummel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497703854 PECOS PAC ID: 1850363532 Enrollment ID: I20090921000021 |
| Provider Name | Wonda F Elmore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053546556 PECOS PAC ID: 7315084092 Enrollment ID: I20091029000082 |
| Provider Name | Michelle A Parra |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679805048 PECOS PAC ID: 4385789338 Enrollment ID: I20100302000964 |
| Provider Name | Terra Brunson-doll |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558598169 PECOS PAC ID: 1153458476 Enrollment ID: I20100419000502 |
| Provider Name | Janet E Robinson |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1467771576 PECOS PAC ID: 0941324503 Enrollment ID: I20100902001092 |
| Provider Name | Bryan Alan Ciula |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1891798815 PECOS PAC ID: 7113114257 Enrollment ID: I20101215000218 |
| Provider Name | Richard E Ruhrold |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1336139583 PECOS PAC ID: 0840479143 Enrollment ID: I20110119000291 |
| Provider Name | Lisa M Wooley |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1891785192 PECOS PAC ID: 8729267331 Enrollment ID: I20110128000520 |
| Provider Name | Stacy M Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407139546 PECOS PAC ID: 8628241445 Enrollment ID: I20111024000019 |
| Provider Name | Mary Dugan Marx |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184932923 PECOS PAC ID: 6507021466 Enrollment ID: I20120628000006 |
| Provider Name | Kishore Sriram |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1710179908 PECOS PAC ID: 8527218114 Enrollment ID: I20121016000598 |
| Provider Name | Candace Lemke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043446776 PECOS PAC ID: 7719137751 Enrollment ID: I20121026000740 |
| Provider Name | Santosh Maharjan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1073751616 PECOS PAC ID: 0941451967 Enrollment ID: I20121121000092 |
| Provider Name | Hester S Liebetrau |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1043528235 PECOS PAC ID: 9234370859 Enrollment ID: I20130724000763 |
| Provider Name | Rhonda Irene Hall |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790128510 PECOS PAC ID: 6103068176 Enrollment ID: I20130805000571 |
| Provider Name | Michelle Kay Kloster |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1528395951 PECOS PAC ID: 2860626611 Enrollment ID: I20131009001629 |
| Provider Name | Alissa M Whittaker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033540638 PECOS PAC ID: 0749403988 Enrollment ID: I20140515002079 |
| Provider Name | Ruth Damilola Adepetun |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518362862 PECOS PAC ID: 8921323437 Enrollment ID: I20150204000464 |
| Provider Name | Bimala Devkota |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972984599 PECOS PAC ID: 1153632716 Enrollment ID: I20150623002256 |
| Provider Name | Ashley H Boettcher |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437527892 PECOS PAC ID: 7517275381 Enrollment ID: I20150928001135 |
| Provider Name | Kathleen C Freet |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1659712701 PECOS PAC ID: 2769792340 Enrollment ID: I20151111000748 |
| Provider Name | Melanie E Stauss |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1841548153 PECOS PAC ID: 0749590164 Enrollment ID: I20151113001433 |
| Provider Name | Ashley Erin Hunter |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1346642576 PECOS PAC ID: 2860795994 Enrollment ID: I20160125001226 |
| Provider Name | Erica L. Parr |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720389745 PECOS PAC ID: 6901100064 Enrollment ID: I20160210000728 |
| Provider Name | Andrew S Yoder |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1144690728 PECOS PAC ID: 3779882741 Enrollment ID: I20160425002393 |
| Provider Name | Chantal T Trent |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871959908 PECOS PAC ID: 7517250053 Enrollment ID: I20160721001555 |
| Provider Name | Ashley D Mcginn |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1225459191 PECOS PAC ID: 0446544522 Enrollment ID: I20160812000207 |
| Provider Name | Elisabeth A Barahona |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1699119586 PECOS PAC ID: 8628357977 Enrollment ID: I20161109002457 |
| Provider Name | Karla S Benitez Estrada |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417239021 PECOS PAC ID: 3971887498 Enrollment ID: I20170301001686 |
| Provider Name | Kelly N Martinczak |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801149729 PECOS PAC ID: 2466711841 Enrollment ID: I20180110000552 |
| Provider Name | Amber Joy Richards |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578977385 PECOS PAC ID: 7315206141 Enrollment ID: I20180124000054 |
| Provider Name | Tayler B Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619349230 PECOS PAC ID: 9335401504 Enrollment ID: I20180328001076 |
| Provider Name | Holly Hirschy-hurd |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275932741 PECOS PAC ID: 2466715065 Enrollment ID: I20180412002166 |
| Provider Name | Heather Gorball |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528473931 PECOS PAC ID: 9931463072 Enrollment ID: I20180426000354 |
| Provider Name | Jonathan Levi |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1538155023 PECOS PAC ID: 2567624687 Enrollment ID: I20180503000240 |
| Provider Name | Nicholas J Todoran |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1003369273 PECOS PAC ID: 8628325933 Enrollment ID: I20180718000987 |
| Provider Name | Marina C Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841637337 PECOS PAC ID: 8123260585 Enrollment ID: I20180719002614 |
| Provider Name | Pamela Sue Thornton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609361062 PECOS PAC ID: 2567710619 Enrollment ID: I20180806001757 |
| Provider Name | Cinnamon L Carlson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548769490 PECOS PAC ID: 7416207741 Enrollment ID: I20180907001919 |
| Provider Name | Andrew Smith |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1295171734 PECOS PAC ID: 9537420245 Enrollment ID: I20181107002889 |
| Provider Name | Dawn Boughton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578935235 PECOS PAC ID: 2769727031 Enrollment ID: I20181214002929 |
| Provider Name | Jennifer Linarello |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215066105 PECOS PAC ID: 6800133661 Enrollment ID: I20190201000122 |
| Provider Name | Rebecca Shaffer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790142156 PECOS PAC ID: 6709123599 Enrollment ID: I20190201001383 |
| Provider Name | Karalynn Michal Brown |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417315433 PECOS PAC ID: 4486995321 Enrollment ID: I20190403000479 |
| Provider Name | Tammy L. Truijens |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1073981866 PECOS PAC ID: 9739412826 Enrollment ID: I20190604002589 |
| Provider Name | Angela Romano |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487810537 PECOS PAC ID: 9638406630 Enrollment ID: I20190814001803 |
| Provider Name | Sandy Imanse |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023050382 PECOS PAC ID: 9830135250 Enrollment ID: I20191010002834 |
| Provider Name | Melissa Ann Terry |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083255855 PECOS PAC ID: 9234561804 Enrollment ID: I20191120000960 |
| Provider Name | Ambreen Ghori |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1326458514 PECOS PAC ID: 5496046732 Enrollment ID: I20200116002797 |
| Provider Name | Kathleen Leckrone |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275171308 PECOS PAC ID: 1456788959 Enrollment ID: I20200221002569 |
| Provider Name | Diane E Stiles |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598871246 PECOS PAC ID: 3274960794 Enrollment ID: I20200224000641 |
| Provider Name | Miranda Ellen Renee Kolde |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477066538 PECOS PAC ID: 6901235837 Enrollment ID: I20200328000078 |
| Provider Name | Werner R Wolff |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598395238 PECOS PAC ID: 5991126229 Enrollment ID: I20200522000309 |
| Provider Name | Miky Kaushal |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1386029098 PECOS PAC ID: 7618273798 Enrollment ID: I20200706000762 |
| Provider Name | Bethany S Kellogg |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295245835 PECOS PAC ID: 8123442993 Enrollment ID: I20200727001809 |
| Provider Name | Emilee King |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346794997 PECOS PAC ID: 2860817202 Enrollment ID: I20200803001373 |
| Provider Name | Kieran L. Jackson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821518226 PECOS PAC ID: 4688091580 Enrollment ID: I20200824001596 |
| Provider Name | Kaitlin O. Weikart |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437617792 PECOS PAC ID: 6901223486 Enrollment ID: I20200828001342 |
| Provider Name | Courtney Nicole Ugel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548806029 PECOS PAC ID: 6709203862 Enrollment ID: I20200903001602 |
| Provider Name | Kelli Marie Rhodes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801402128 PECOS PAC ID: 5395164289 Enrollment ID: I20200925001586 |
| Provider Name | Aurora Anne Griffin |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1386013787 PECOS PAC ID: 1658790506 Enrollment ID: I20200928000880 |
| Provider Name | Megan Nicole Marsh |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1861862419 PECOS PAC ID: 0648690065 Enrollment ID: I20201022004155 |
| Provider Name | Crystalia Weidner |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1871072348 PECOS PAC ID: 0840601670 Enrollment ID: I20201130000396 |
| Provider Name | Michael John Dewinter |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1841889011 PECOS PAC ID: 0143633032 Enrollment ID: I20210114000893 |
| Provider Name | Alisa N Briones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740821925 PECOS PAC ID: 6507274008 Enrollment ID: I20210428000674 |
| Provider Name | Amber M. Hiss |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1063977833 PECOS PAC ID: 2860801990 Enrollment ID: I20210503000311 |
| Provider Name | Amber Rose Stutzman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811566169 PECOS PAC ID: 8820494982 Enrollment ID: I20210915001245 |
| Provider Name | Eric Eugene Spohn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104580711 PECOS PAC ID: 8022407774 Enrollment ID: I20211118000331 |
| Provider Name | Pamela Jean Stopczynski |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457481848 PECOS PAC ID: 7911397625 Enrollment ID: I20211210001472 |
| Provider Name | Malinda K Shelley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841962669 PECOS PAC ID: 5991196875 Enrollment ID: I20220104000922 |
| Provider Name | Emily Christine Vanderpool |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841865003 PECOS PAC ID: 0143612739 Enrollment ID: I20220111000850 |
| Provider Name | Amanda Rose Miller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053968172 PECOS PAC ID: 3274911045 Enrollment ID: I20220607001548 |
| Provider Name | Cassandra G Winters |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790326312 PECOS PAC ID: 4183005812 Enrollment ID: I20220713000519 |
| Provider Name | Danielle L. Creech |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508419078 PECOS PAC ID: 1658755764 Enrollment ID: I20220908001039 |
| Provider Name | Alicia Eluere |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851043715 PECOS PAC ID: 0749665503 Enrollment ID: I20220914001685 |
| Provider Name | Christina Carradine |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053864025 PECOS PAC ID: 0446545420 Enrollment ID: I20220916000894 |
| Provider Name | Samantha Lynne Fredrickson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659008670 PECOS PAC ID: 5294110821 Enrollment ID: I20220919002276 |
| Provider Name | Tabitha Gabbard |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881252641 PECOS PAC ID: 2163890120 Enrollment ID: I20221122002355 |
| Provider Name | Traci Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609473834 PECOS PAC ID: 1254701378 Enrollment ID: I20230106001337 |
| Provider Name | Jade E. Brown |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1063073187 PECOS PAC ID: 9032589155 Enrollment ID: I20230106001524 |
| Provider Name | Alex D. Kellogg |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629535034 PECOS PAC ID: 0446620561 Enrollment ID: I20230106001816 |
| Provider Name | Sierra Lynn Coulahan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1003499450 PECOS PAC ID: 6406226430 Enrollment ID: I20230106002597 |
| Provider Name | Anthony B Centlivre |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255051231 PECOS PAC ID: 6406226216 Enrollment ID: I20230111002317 |
| Provider Name | Jennifer A Deneen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558018911 PECOS PAC ID: 6406221092 Enrollment ID: I20230413000387 |
| Provider Name | Katrina Jean Vargas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235830043 PECOS PAC ID: 5698140192 Enrollment ID: I20230414002231 |
| Provider Name | Victoria Dibiase |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447857602 PECOS PAC ID: 6507222486 Enrollment ID: I20230518002664 |
| Provider Name | Scout Burns |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568169019 PECOS PAC ID: 3678939410 Enrollment ID: I20230519002035 |
| Provider Name | Rachel Speer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720779408 PECOS PAC ID: 4183081359 Enrollment ID: I20230601003179 |
| Provider Name | Robbillie Stevenson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154971919 PECOS PAC ID: 1052778016 Enrollment ID: I20230606002936 |
| Provider Name | Cierra Young |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053013151 PECOS PAC ID: 1557728359 Enrollment ID: I20230609002504 |
| Provider Name | Fay Angella Roberts |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023720984 PECOS PAC ID: 1850752908 Enrollment ID: I20230804002761 |
| Provider Name | Laura Borsa |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477234201 PECOS PAC ID: 8426419581 Enrollment ID: I20230804003104 |
| Provider Name | Leah Christine Sands |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467135285 PECOS PAC ID: 0648632323 Enrollment ID: I20230811001369 |
| Provider Name | Tracy Manns |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326821026 PECOS PAC ID: 0143682385 Enrollment ID: I20230818003307 |
| Provider Name | Jennifer Lynn Kracium |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952919524 PECOS PAC ID: 9830553338 Enrollment ID: I20230918001468 |
| Provider Name | Amanda Christine Pearcy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902144066 PECOS PAC ID: 5890140669 Enrollment ID: I20231013002207 |
| Provider Name | Emily Taylor |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548867989 PECOS PAC ID: 7719332592 Enrollment ID: I20231013002613 |
| Provider Name | Lauren Campbell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669154886 PECOS PAC ID: 8022463686 Enrollment ID: I20231017002115 |
| Provider Name | Katie A Grabe |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1740836097 PECOS PAC ID: 2668821455 Enrollment ID: I20231205002285 |
| Provider Name | Marla A Vandegrift |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1396993069 PECOS PAC ID: 5294184891 Enrollment ID: I20231207002824 |
| Provider Name | Charles Matthew Butler |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1669062956 PECOS PAC ID: 1456701366 Enrollment ID: I20231219000377 |
| Provider Name | Clint Alan Plattner |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1588258131 PECOS PAC ID: 0749630309 Enrollment ID: I20231221002921 |
| Provider Name | Benjamin Pollock |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1417591736 PECOS PAC ID: 8921458514 Enrollment ID: I20231221003992 |
| Provider Name | Mary K Pequignot |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1871833889 PECOS PAC ID: 2769832377 Enrollment ID: I20231222000557 |
| Provider Name | Kellie Woll |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1528351046 PECOS PAC ID: 0547610040 Enrollment ID: I20231226000746 |
| Provider Name | Andrew Sebastian |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1275882581 PECOS PAC ID: 9436509932 Enrollment ID: I20231226000814 |
| Provider Name | Charlotte Mock |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1578193058 PECOS PAC ID: 0042660326 Enrollment ID: I20231228002945 |
| Provider Name | Christina L Bolden |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1912211996 PECOS PAC ID: 4284084575 Enrollment ID: I20231228003172 |
| Provider Name | Jessica N Bland |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1518450725 PECOS PAC ID: 7012367253 Enrollment ID: I20231229001387 |
| Provider Name | Jennifer S Mitchell |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1851372338 PECOS PAC ID: 6800246083 Enrollment ID: I20231229002741 |
| Provider Name | Jennifer Aileen Pappert |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1689318727 PECOS PAC ID: 1658721717 Enrollment ID: I20240102002101 |
| Provider Name | Catherine Marie Jantzen |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1669489985 PECOS PAC ID: 6901856236 Enrollment ID: I20240108004500 |
| Provider Name | Riley Powell |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1225574981 PECOS PAC ID: 0840641312 Enrollment ID: I20240109002610 |
| Provider Name | Erin Hollowell |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1306211230 PECOS PAC ID: 1052763075 Enrollment ID: I20240116001048 |
| Provider Name | Jessica Hermosillo Gaytan |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1659888089 PECOS PAC ID: 5496107435 Enrollment ID: I20240116001535 |
| Provider Name | Janet Shull |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1821304452 PECOS PAC ID: 5294187266 Enrollment ID: I20240116002627 |
| Provider Name | Stacy Hellinga |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1609324110 PECOS PAC ID: 3173975059 Enrollment ID: I20240116003040 |
| Provider Name | Amy Wargowsky |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366222549 PECOS PAC ID: 6204288061 Enrollment ID: I20240117001498 |
| Provider Name | Lindie M Leary |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1326279266 PECOS PAC ID: 1456703982 Enrollment ID: I20240119001788 |
| Provider Name | Danielle Renee Rhinesmith |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1730353871 PECOS PAC ID: 8729430269 Enrollment ID: I20240119001828 |
| Provider Name | Stephen Alexander Konz |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1780680694 PECOS PAC ID: 2264884709 Enrollment ID: I20240119001886 |
| Provider Name | Ashley L. Mcwhirter |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1699284232 PECOS PAC ID: 3375995848 Enrollment ID: I20240119002881 |
| Provider Name | Baily Michele Kakalia |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275315954 PECOS PAC ID: 5294187696 Enrollment ID: I20240122003234 |
| Provider Name | Desiree Schutte |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1003308883 PECOS PAC ID: 7911359260 Enrollment ID: I20240123000518 |
| Provider Name | Wayne Crowder |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1649810730 PECOS PAC ID: 3779935069 Enrollment ID: I20240123001765 |
| Provider Name | Melissa Marie Clemmer |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1710538442 PECOS PAC ID: 3971955162 Enrollment ID: I20240124000444 |
| Provider Name | Rosalinda Torres |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1528407566 PECOS PAC ID: 8224481494 Enrollment ID: I20240124003479 |
| Provider Name | Jessica Leigh Hatcher |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1336812155 PECOS PAC ID: 3678926730 Enrollment ID: I20240125001892 |
| Provider Name | Jessica Erebor |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1649761503 PECOS PAC ID: 8628421609 Enrollment ID: I20240125002830 |
| Provider Name | Shane M. Bullick |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1285295394 PECOS PAC ID: 7517310501 Enrollment ID: I20240125003290 |
| Provider Name | Nicholas Ray Brauchler |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1144820192 PECOS PAC ID: 5597118505 Enrollment ID: I20240125004182 |
| Provider Name | Aaron Crump |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1497316194 PECOS PAC ID: 9931552460 Enrollment ID: I20240131002189 |
| Provider Name | Sandra D Nowlin |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1538410428 PECOS PAC ID: 6901259480 Enrollment ID: I20240131003959 |
| Provider Name | Mercedes Royletta Horace |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1346726361 PECOS PAC ID: 5092168401 Enrollment ID: I20240201000282 |
| Provider Name | Patrick J Chesebrough |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1265001457 PECOS PAC ID: 2365885605 Enrollment ID: I20240203000331 |
| Provider Name | Mackenzie Taylor Rice |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1871019844 PECOS PAC ID: 2668815861 Enrollment ID: I20240205002387 |
| Provider Name | Jeremy Richard Digia |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1295767713 PECOS PAC ID: 5092158204 Enrollment ID: I20240205002527 |
| Provider Name | Tonya J Eiden |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1013950088 PECOS PAC ID: 0345683363 Enrollment ID: I20240207000798 |
| Provider Name | Melissa Pearman |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1306233887 PECOS PAC ID: 2062855018 Enrollment ID: I20240207001645 |
| Provider Name | Sonja Lynn Lingo |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1356558092 PECOS PAC ID: 2668815549 Enrollment ID: I20240207003236 |
| Provider Name | Abigail Clements |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1447662515 PECOS PAC ID: 2860835394 Enrollment ID: I20240212002007 |
| Provider Name | Ericka A Kaufman |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1184952475 PECOS PAC ID: 1557704020 Enrollment ID: I20240212003281 |
| Provider Name | Kevin J Brown |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1659374791 PECOS PAC ID: 4880038280 Enrollment ID: I20240213004005 |
| Provider Name | Joshua Nicholson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1720457534 PECOS PAC ID: 2163866476 Enrollment ID: I20240214003213 |
| Provider Name | Holly Marie Buckler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801673256 PECOS PAC ID: 6608210455 Enrollment ID: I20240220002335 |
| Provider Name | Cheryl Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467083113 PECOS PAC ID: 4284078098 Enrollment ID: I20240220004598 |
| Provider Name | Esther E Wilcox |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1538652730 PECOS PAC ID: 8820432545 Enrollment ID: I20240221000517 |
| Provider Name | Yi Hui Chi |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1396133591 PECOS PAC ID: 0941644538 Enrollment ID: I20240222002011 |
| Provider Name | Lauren Cooper |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1376249656 PECOS PAC ID: 2264877729 Enrollment ID: I20240224000090 |
| Provider Name | Lauren Elizabeth Hoppenrath |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1982294278 PECOS PAC ID: 9335584812 Enrollment ID: I20240224000550 |
| Provider Name | Vicki E Ley |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1992701809 PECOS PAC ID: 9436594868 Enrollment ID: I20240226001711 |
| Provider Name | Sarah Carlson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326687609 PECOS PAC ID: 4880039155 Enrollment ID: I20240226003401 |
| Provider Name | Oluwabunmi Oluwatosin Adenuga |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568021848 PECOS PAC ID: 5395180558 Enrollment ID: I20240227002885 |
| Provider Name | Benny Lee Powell |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1215163316 PECOS PAC ID: 0143665224 Enrollment ID: I20240228002669 |
| Provider Name | Thomas Adron Cantrell |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1841935749 PECOS PAC ID: 7911342035 Enrollment ID: I20240228004109 |
| Provider Name | Gianna M. Casaburo |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1053804260 PECOS PAC ID: 0244675387 Enrollment ID: I20240228004687 |
| Provider Name | Megan Beeching |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1760096911 PECOS PAC ID: 5092150946 Enrollment ID: I20240229004448 |
| Provider Name | Lynn Ann Baker |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1730262411 PECOS PAC ID: 8123463908 Enrollment ID: I20240302000599 |
| Provider Name | Kyle Mclain |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1306388228 PECOS PAC ID: 0648615443 Enrollment ID: I20240304000637 |
| Provider Name | Donald Henry Starke |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1033192489 PECOS PAC ID: 2961847611 Enrollment ID: I20240304002701 |
| Provider Name | Matthew Richard Riggle |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1699041277 PECOS PAC ID: 6103262779 Enrollment ID: I20240306002436 |
| Provider Name | Susan R Miller |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1710988621 PECOS PAC ID: 6002252905 Enrollment ID: I20240314000787 |
Raising Hope Counseling, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 734 E Center St, Warsaw, IN 46580 Phone: 612-210-4347 | |
Brown & Associates Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 223 S Bronson St, Warsaw, IN 46580 Phone: 574-268-1116 Fax: 574-268-1176 | |
Mcarthur Mental Health Services Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 3201 E Center Street Ext, Warsaw, IN 46582 Phone: 574-267-1700 Fax: 574-267-0017 | |
Mcarthur Mental Health Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 3201 E. Center St. Ext., Warsaw, IN 46582 Phone: 574-267-1700 Fax: 574-267-0017 | |
Allied Physicians Inc., D/b/a Fort Wayne Neurology Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1000 Med Park Dr, Suite D, Warsaw, IN 46580 Phone: 574-269-8320 | |
Selah Christian Center Inc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 201 N Roosevelt St, Warsaw, IN 46580 Phone: 574-269-3008 | |
Healing Road Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1403 Tanager Dr, Warsaw, IN 46580 Phone: 574-377-9857 |